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'4 STJOSEP-05 WALD ENKI DATE (M AfDDNYY-Y) CERTIFICATE OF LIABILITY INSURANCE J 5127/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT _NAME: Willis Towers Watson Certificate Center Willis Insurance Services of California, Inc. PHONE (877) 945-7378 FAX AIC N (AIC� No): (888) 467-2378 c/o 26 Cent BI d E-MAIL P.O. Box 305791 Nashville, TN 37230-5191 ADDRESS: certificates @wil IS.Com INSURER(S) AFFORDING COVERAGE J NAIC 4 INSURER A: Safety National Casualty Corporation 11510-5-- INSURED INSURER 8 Sisters of St. Joseph of Orange !N§qRKR 9-: . .. .... 480 South Batavia INSURER D; Orange, CA 92868 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRCBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ... .... ... ..... LTR TYPE OF INSURANCE ADDLSUBR ...POLICY NUMBER POLICY Err POLICY EXP LIMITS y YL COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE CLAIMS-MADE n, OCCUR PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE LOC . ......... POLICY E PRO- F PRODUGTS - COMPYOPAGG JECT OTHER COMBINED SINGLE AUTOMOBILE LIABILITY LIMIT accioent) ..... . ......... . ... . ... ....... ANY AUTO BODILY INJURY IPer person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-,OWNED PROPERTY DNA, d1F.1_ $ HIRED AUTOS AUiOS (Per acddenl ) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ P WORKERS COMPENSATION X "'RT... 0'"" J ST AND EMPLOYERS'LIABILITY YIN A ANY PROPRIETORIPARTNERIEXECUTIVE [ LDS4052992 0513112016 05/3112017 E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? IN NJA (Mandatory in NH) E L, DISEASE - FA EMPLOYEE $ 1,000,000 If yes, deschbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 ------------ _. . .... DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 10, Additional Remarks Schedule, maybe attached if more space is required) Re: SSJO dba Tailor San Jose, Block Grant, 810 N. Poinsetta, Santa Ana, CA 92701 CERTIFICATE HOLDER CANCELLATION . ....... . .. " . .. ....... .... ... .. SHOULD, ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana, its officers, agents AUTHORIZED REPRESENTATIVE Attn: Lucy Flores 20 Civic Center Plaza; No. M25 - P.O. Box 1980 �Santa Ana, CA 92702 CJ Oc 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD